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Friday, August 28, 2015

It's a somewhat surreal election campaign that is currently in full swing in Canada. It stays clear of issues of vital importance to Canada and Canadians. There we have a rapidly ageing population and really we need a national seniors strategy that accounts for that. One can nearly feel sorry for the Canadian Medical Association here. The association tried hard during the last few months to make this issue an issue in the current election campaign. It was rightly supported by sympathetic journalists such as the Globe and Mail's Andre Picard. Yet, for all those efforts, the issue gained no traction with any of the major parties. Our federal leaders' heads remain firmly planted deep in sand, with no effort made to look ahead and address major, dramatic challenges to our health care system. Instead we were treated to a good two weeks' worth of Mike Duffy and the usual corrupt shenanigans that are a hallmark of Prime Minister Harper's political operation.

I spoke yesterday to a journalist interviewing me on the state of federal and provincial planning with regard to the implementation of our Supreme Court's decision on assisted dying. He asked why the political parties, in my estimation, haven't taken up this issue in their respective campaigns? He was puzzled that an issue that enjoys broad support among Canadians is ignored by the major political parties. What was I to say other than 'I don't get it either'. A new poll, released today, confirms what I told the journalist yesterday, it is not only the case that the vast majority of Canadians want to see the decriminalization of assisted dying, it is also the case that the vast majority of conservative party voters supports the decriminalization. 77% of Canadians generally support decriminalization and a whopping 67% of conservative party voters and 84% of NDP voters. This does beg the question why none of the mainstream parties have leveled with their supporters and the general voting public on how they would implement the Supreme Court judgment. I do still wonder why Prime Minister Harper appointed an advisory panel stacked with discredited anti-choice activists, given that the majority of his party's supporters is in favor of decriminalization. Why on earth would he stack his panel with folks known to be opposed to decriminalization? I sometimes wonder about the credit that is given to Mr Harper who is hailed as a master political tactician. His whole election campaign seems a shambles to me.

Tuesday, August 25, 2015

The Canadian Medical Association currently debates the issue of assisted dying. That's a reassuring thing as everything points in the direction of doctors becoming the gatekeepers once assisted dying is regulated and will be made available to eligible Canadians who request it.

Strangely, the Association seems to put a lot of store in an on-line poll it inflicted on its members, where only 29% of those who responded said that they were willing to provide assisted dying to eligible patients while 63% objected. I'm surprised the Association's staff would have even mentioned this survey. It's troubled by obvious ( and quite deadly, pardon the pun) methodological problems that renders it useless.

The Associations Vice President Professional Affairs, Dr Jeff Blackmer produced a 34 slide presentation titled (no doubt to the horror of most living medical ethicists) 'End-of-Life Care in Canada: A Principles Based Approach to Assisted Dying'. There will be only few people left in bioethics who have not come to realize that the much celebrated principles approach to medical ethics guarantees arbitrary recommendations and outcomes. The principles approach is neither action guiding nor action justifying, it's useless as a tool of ethical or policy analysis and justification. Blackmer decided to add random other principles to the Georgetown Mantra, including vacuous nice sounding stuff like the 'dignity of life' (yes, really, he did!). We spent a fair amount of time in our Royal Society of Canada Report on the subject matter dissecting this particular issue.

After delivering to his audience this hotchpotch of principles, there's an unconnected slide with recommendations, followed by 8 or 9 slides reporting the results of the CMA's on-line poll. Blackmer reports that of about 80 000 doctors in Canada about 1400 clicked their way thru the on-line poll. At a minimum the negligible turnout suggests that most doctors in Canada didn't care to complete a survey that they probably realized ultimately tells us nothing about Canadian doctors' views on assisted dying. The reason for this is methodological. These kinds of surveys may or may not be representative, we just cannot know, because the survey participants may or may not be representative. If anything we should be suspicious of these results, because no professional survey organisations ensured that the sample was actually representative. Those who feel strongly about the subject matter - physicians opposed to it - will fire up their supporters to reject assisted dying and proclaim no collaboration.

Other surveys, including one reported in our above mentioned report, suggest significantly higher levels of support. It is all the more disheartening that a seasoned journalist like the Globe and Mail's Andre Picard takes the 29% figure at face value in his twitter reporting of the Blackmer presentation. (See the image above.) Doing that permits the anti-choice activists to feel good about their campaign strategy, their encouraging their like-minded doctor supporters to click thru the survey would pay off if people fell for this nonsense. I left a slightly more polite comment to this account under Blackmer's public slide presentation, but it was quickly deleted. Go figure.

The CMA recognizes that we will be getting assisted dying in some form or shape (determined by the criteria set out in the Supreme Court of Canada judgment on this subject) and that a small number of its members will be called upon to provide assisted dying services to their patients. The Association is rightly concerned about ensuring patient access while protecting its objecting members' conscience choices. There is a precedent for this. Abortion. Objecting doctors will be obliged to transfer their patients to a colleague they know will oblige them, without unreasonable delay. The CMA is apparently supportive of this compromise.

The train toward assisted dying in Canada has departed but hasn't reached its destination yet.

Wednesday, August 19, 2015

We, concerned members of the blogging and activist community of Bangladesh and internationally, along with representatives of human rights organisations and other civil society organisations and supporters, wish to protest in the strongest possible terms the institutional attack on Bangladeshi citizens who profess humanist, atheist or secularist views.

In the last two years, five bloggers (variously identifying as humanist, rationalist, atheist, and variously writing about science, humanist values, against Islamist extremism, or in favour of human rights and justice) have been murdered, hacked to death by assailants acting for fundamentalist militant groups (according to their own claims of responsibility). These victims are: Ahmed Rajib Haider, the science author Avijit Roy, Washiqur Rahman Babu, Ananta Bijoy Das, and Niladri Chatterjee (pen name Niloy Neel). Four of these murders have occurred since February this year. In other cases, individuals like Jafar Munshi and Anjali Devi have been killed for alleged or perceived acts of ‘defamation of religion’, such as refusing to enforcehijabon students. And since 2013, supporters of the Shahbag movement and the war crimes justice process (the accused being Islamist leaders) have also been brutally murdered by similar Islamist entities. The victims include: Ashraful Alam, Arif Raihan Deep, Nurul Islam Faruki, Jagat Jyoti Talukder, Jakaria Babu.

The murderers and their ideological supporters are of course to be condemned and must be brought to justice.

In addition, instead of helping to confront this outrageous injustice, political and state institutions have begun blaming the victims themselves and making matters worse.

Following the murder of Niladri Chatterjee on 7 August, the Inspector General of Police engaged in victim-blaming, called for self-censorship, and threatened bloggers — the very people who are being murdered — with legal action under the current quasi-blasphemy law. Meanwhile, despite some counter-terrorism operations, the police have comprehensively failed to disrupt the networks that are ordering or carrying out these cowardly attacks. Even with two of the killers caught at the scene (after the murder of Washiqur Rahman) and claims of responsibility made openly on social media and via news outlets, still the attacks go on, and the extremists behind the killings remain at large. Instead of calling for vigilance and evidence against the murderers from the general public, police have instead encouraged the public to report alleged atheistic writings.

Faced with fresh death threats against numerous named Shahbag activists and others branded “enemies of Islam” in the week after the most recent murder, a police spokesperson told those threatened merely to “lodge police complaints” if they thought they were being followed! This is a grossly inadequate, highly negligent response to what is evidently a most serious and potentially fatal threat.

A number of Islamist groups, including Awami Olama League which isclosely associated with your own Awami League party, havemade new demands of death penalties for all atheist bloggers and activists, echoing the rhetoric of Islamist extremists in other parties. Obviously, this demand represents a gross violation of the rights of the non-religious to freedom of thought, and against freedom of expression generally and must be firmly and explicitly rejected.

Furthermore, your Cabinet Committee for Law and Order, headed by Minister of Industries Amir Hossain Amu, on their 9 August 2015 meeting decided “to declare Atheist authors as criminals”, thereby making them subject to prosecution, and intelligence agencies have been asked to monitor blogs to find those atheist writers. Even under the current law, such a mass arrest of people who profess non-religious views in their online communications would represent a grave violation of the international human rights obligations to which Bangladesh is committed. The Home Minister in a separate speech was seen repeating the same warning message.

These institutions and officials of the state through their current stances — demonising free expression, while appeasing murderous extremists — are destroying Bangladesh’s claim to be a democratic state that upholds the human rights of all citizens. To criminalize the expression of “anything that may hurt anyone’s religious sentiments or beliefs” (as the Inspector General of Police puts it) means in practice that fundamentalists and extremists can say and do anything they want, while anyone who stands for democracy, free expression, rationalism, justice, and human rights would be reduced to silence.

This is a recipe for a theocratic state in thrall to the most extremist members of society. People must be able to discuss and debate religion and politics, beliefs and practices. If they cannot, then injustice, fear and violence will reign.

To fail to confront and refute these oppressive and illiberal tendencies now, will mark the beginning of the end of Bangladesh as a free and democratic country.

We implore you to:

ensure the safety and security of those individuals whose lives are threatened by Islamist extremists, including the witnesses and family members

instruct the police to find the killers, not to harass or blame the victims

disassociate yourself publicly from those who call for death penalties against non-religious Bangladeshis, and ensure using your executive authority that individuals within your party membership maintain the same standard of respect for freedom of conscience and expression

work decisively for legal reform to repeal Section 295A of the Penal Code and section 57 of the ICT Act of 2006, in order to bring the legal system of Bangladesh in line with the spirit and values of freedom of expression and ‘of conscience’ as enshrined in the Constitution of Bangladesh, and as per obligations under the international human rights instruments to which Bangladesh is party.

[Full list of signatories follows below the Bangla version of this statement]

The signatories include threatened Bangladeshi bloggers and activists, representatives of organisations focused on human rights including freedom of expression or freedom of belief, religious and secular groups, and also individual writers, journalists, artists, academics and other professionals with Bengali connection or in solidarity.

Friday, August 14, 2015

You might recall that the Canadian federal government established an external panelto advise it on legislative options on assisted dying. Telling the Supreme Court of Canada what he really thinks of it, Harper then stacked the panel with anti-choice activists.

Quite clearly Canada's provinces were unwilling to let that charade continue without doing something about it. Today, in a very welcome development, they announced a joint expert panel advising the provinces on how to respond to the Supreme Court judgment. It is a much larger panel consisting of experts with a wide variety of competencies, including nursing, medicine, law and ethics, and comprising of experts from across Canada.

I am certainly looking forward to the results this panel will produce.

Tuesday, August 11, 2015

The Australia based Journal of Bioethical Inquiry has recently published two papers[1],[2]
by the same group of authors. One of these papers was a Letter to the Editor,
hence it is not entirely clear whether or not it was peer reviewed. Let’s call
this paper Paper One. It was
published in 2013. Another paper was published in 2015, the journal mentions
that this paper was externally peer reviewed. Let’s call this paper Paper Two. Each of these papers targets
editorial and commercial practices of major English language bioethics journals
or their publishers. Both papers are Open Access at the time of writing, I
encourage you to take the time to read them for context.

This blog entry responds to both papers. My primary objective is to show that each paper fails
in each mission.

Let us start with Paper One. The authors aimed here to
investigate whether bioethics journals are variously ‘institutionally racist’
or ‘editorially biased’. They tried to achieve this by using the following
method. They investigated the composition of major journals’ Editorial Boards –
no content analysis was undertaken as part of this research project. The
authors of this paper then grouped Editorial Board members into various categories
according to where they live in terms of their countries’ rankings in the Human
Development Index. Surprisingly – and
evidently unjustifiably so - this paper then proceeded to grouping the
Editorial Board members into three categories (the HDI offers four[3]).
It grouped Editorial Board members into Very High and High HDI, Medium HDI and
Low HDI. The paper then notes indignantly that the vast majority of Editorial
Board members belong into the first group of HDI countries. It turns out, by
grouping Very High and High HDI countries into one category, these authors
created arguably artificially the result required for their scathing critique.
Unsurprisingly they found that the vast majority of Editorial Board member hail
from countries that are either Very High or High HDI. However, a closer look
into these categories reveals that the following countries can be found in their
amalgamated first category: Germany and Libya, Mexico and Switzerland, Iran and
the United States, Sri Lanka and Liechtenstein, and so on and so forth. Quite
clearly, many countries belonging to the global south were unjustifiably folded
into the global north category to achieve the desired outcome, namely
blameworthy bioethics journals having an insufficient number of Editorial Board
members hailing from the global south.

As mentioned already, Paper One also failed to undertake an
actual content analysis. Bioethics established some 15 years ago its own
specialised developing world focused companion journal called Developing World Bioethics. In case you
wonder whether that meant shunting articles aside into a global south niche
category, nothing could be further from the truth. Developing
World Bioethics has currently the second highest Impact Factor of bona fide
bioethics journals, as measured by the Institute for Scientific Information.
All of this escaped the authors of this paper, because they were primarily
concerned with the composition of the Editorial Board of Developing World Bioethics, an Editorial Board they happily
castigated for having insufficient representation from the global south,
because by these authors’ definition, for instance the journal's Mexican and Sri Lankan
Editorial Board members don’t quite count as representatives of countries of
the global south.

Paper Two proceeds in this methodological vein. The focus is
on purportedly greedy publishers and general bioethical imperialism. Like in
the first paper, hyperbole remains a strong selling point of these authors. The
target this time are paywalls. Most journals in our field are subscription
based journals, which is partly a function of the fact that most authors
publishing in bioethics journals do not have access to the funds required to
publish in pay-for-play Open Access journals. That also means that access to
the content we publish is restricted to subscribers, typically subscribing
university libraries. Individual articles are available for sale to people
interested in purchasing them. Paper Two then proceeds to investigate the
question of whether mainstream or leading bioethics journals are available to
academics working in the global south. This actually is an important issue and
as an Editor of Bioethics and Developing World Bioethics I have always
cared passionately about affordable or complimentary access for academics
working in the global south. Leading academic publishers, including Wiley-Blackwell,
the publisher of Bioethics, are founding members of myriad access schemes
aimed at ensuring that academics in the global south have access to the content
we publish. Knowledge is power after all. Among these schemes is HINARI, a
scheme administered by the World Health Organisation. There are other schemes,
AGORA and OARE among them.

The authors
of Paper Two apparently investigated whether leading English language bioethics
journals are available via HINARI. That is a fair enough approach, HINARI
covers health related research outputs, so Bioethics
and Developing World Bioethics should
be available thru HINARI, if at all. Paper Two reports erroneously that neither
Bioethics nor Developing World Bioethics are available via HINARI. The authors make the
same erroneous claim about other major journals in the field, including but not
limited to ajob – American Journal of Bioethics,
jme – Journal of Medical Ethics, Journal of Clinical
Ethics, Cambridge Quarterly of Healthcare Ethics, Journal of Law, Medicine and
Ethics, Journal of Medicine and Philosophy, Journal of Bioethical Inquiry.

It is worth noting here that the authors of Paper Two did
not bother confirming with me or my fellow editors, or with our publishers,
whether these journals are really not
made available free of charge or at very low cost to academic institutions in LMIC
countries. Apparently, confirming with the editors of these journals, or their
publishers, that these bioethics journals really
are not available free of charge to authors in the global south was too onerous
for the campaigning authors of Paper Two.
It turns out, not only are Bioethics
and Developing World Bioethics
available via HINARI, but so are our esteemed competitors, namely all of the journals I mentioned above.[4]
There is some irony in the fact that the current Editors of the Journal of Bioethical Inquiry were
unaware of the availability of their very own journal via HINARI. It is
doubtful that they meant to stand idle by while authors slander their journal
in the pages of their own publication.

In light of these facts, I strongly encourage you to read
Paper Two again. The anti-imperialist emperors look pretty naked to me. It’s a
good example for the view that good intentions are not good enough. This
research output reportedly underwent peer review, which goes to show that while
peer review might be the best quality control mechanism there is, it is far
from perfect. Paper Two goes on at great length about the purported profit
motives of greedy publishers and how that impacts access to scientific
information for researchers in the global south, alas its starting premise
turns out to be false.

One would hope the Editors of the Journal of Bioethical Inquiry retract this particular peer reviewed
output at their earliest possible convenience.

[4] A complete list
of accessible journals can be found here, http://extranet.who.int/hinari/en/journalList_print.php?all=true
. [Accessed August 11, 2015] Consider saving the large file as a CSV file
(follow the link offering that option). You will then download a MS Excel file
that can easily be searched for journal titles that you are interested in.